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Mobilization of Visceral Fascia: Urinary System

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will be able to:
1. Describe the theory and application of mobilization of visceral fascial structures relating to optimal function of the urinary system and pelvic floor.
2. Understand the biological plausibility of how alteration of the normal mobility of visceral fascial structures can contribute to pelvic dysfunction
3. Cite potential causes for development of restrictions in the visceral fascia of the urologic system, pelvis, abdomen and thorax
4. Express a clear understanding of the visceral structures within the urinary system and how their normal mobility is associated with somatic and autonomic function
5. Differentiate between direct and indirect release techniques and understand the proper application of each
6. Identify visceral structures with relation to the urinary system via external and internal vaginal landmarks
7. Recognize abnormal tissue mobility and motility of visceral fascial structures
8. Apply the technique of three-dimensional fascial release to visceral structures, utilizing external body and internal vaginal approaches
9. Recognize and treat fascial restrictions throughout the pelvis, abdomen and thorax as they may relate to diagnoses of dysfunction within the urinary system
10. Develop treatment sequencing with respect to global, local and focal fascial restrictions
11. Implement fascial release techniques into a comprehensive treatment program for the patient with varied urologic diagnoses to include incontinence, urgency, retention, and bladder pain as they relate to physical therapy

Target Audience

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Confirmation Notes

Prerequisites:
Pelvic Floor Level 1 through Herman & Wallace or prior seminar instruction in internal pelvic floor vaginal muscle examinations

Required Readings:
1. The Fascial Mechanoreceptors Article from fasciaresearch.com
2. Review the anatomy of the pelvis and perineum
3. Review of Anatomy Terms
4. Participants should bring an anatomy atlas (preferably Netter) for reference of the visceral anatomy.

Agenda

Day One:
4:30 Registration 5:00 Concepts of Visceral Mobilization 6:45 Break 7:00 Concepts of Visceral and Fascial Mobilization 8:15 Direct & Indirect Treatment 9:15 Adjourn

Day Two:
8:00 Review of Fascial Concepts 8:30 Visceral Palpation and Evaluation 9:45 Bladder Lecture: External Approach 10:45 Break 11:00 External Bladder Techniques: Demo and Labs 12:00 1:00 External Bladder Techniques: Demo and labs 2:00 Small & Large Intestine Lecture 3:00 Break 3:15 Small Intestine: Demo and Lab 4:15 Large Intestine: Demo and lab 5:30 Adjourn

Day Three:
8:00 Review of Day 2 & Questions 8:30 Kidney/Ureters Lecture 9:00 Kidney/Ureter Techniques: Demo and lab 9:45 Break 10:00 Urethra & Trigone Lecture: Internal Approach 10:30 Internal Bladder Techniques: Demo and labs 12:00 Lunch 1:00 Visceral anatomy, fetal pig dissection 1:45 Thoracic Relationships 2:15 Thoracic Mobilization: Demo and Lab 3:15 Evaluation, Documentation & Case Study Presentation 4:00 Adjourn

Description

The fascial system consists of four concentric layers, with the visceral layer beginning at the naso-pharynx and ending at the anal aperture. This course will focus on theory and manual therapy technique for mobilizing fascial structures of the visceral system. The abdomino-pelvic canister is a functional and anatomical construct comprised of the somatic structures of the abdominal cavity and pelvic basin, which work synergistically to support the midline of the body. The walls of this canister are occupied by and intimately connected to the visceral structures found within. In order to function optimally the viscera must be able to move, not only in relationship to one another, but with respect to their surrounding container.

Material will be presented that includes the science of and evidence behind the use of fascial based manual therapy with presentation of relevant visceral and fascial anatomy. Emphasis will be placed on clinical reasoning with the goal of immediate implementation of the techniques learned following this introductory course. Students will be instructed in an extensive number of treatment techniques, both external abdominal as well as internal vaginal approaches. Course participants will be able to immediately incorporate evaluation and treatment of visceral fascia for patients with a variety of urinary dysfunction diagnoses

Mobilization of the visceral fascia requires advanced palpation skills along with extensive knowledge of visceral anatomy. This continuing education course is a two-and-a-half day seminar designed to provide comprehensive knowledge concerning the relationship between the connective tissue surrounding the visceral structures of the urologic system as it relates to physical therapy treatment. This course is geared toward the experienced pelvic health therapist who wishes to integrate advanced manual therapy skills into their treatment regimen.

Special Considerations:

As this course includes extensive lab work, all course attendees should come prepared to participate as both clinician and patient. Abdominal and Vaginal pelvic approaches to access visceral structures will be taught in labs. Pregnant attendees may participate in a limited capacity, bringing a model for internal labs will facilitate the best learning experience as vaginal examination and internal myofascial manual therapy prior to 32 weeks gestation is not the common standard of medical practice.

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